Preventable Diseases Part 6

But the resources for mischief of this pharyngeal "Old Man of the Sea"

are not even yet exhausted. Next comes a very curious and unexpected one. We have all heard much of "the struggle for existence" among plants and animals, and have had painful demonstrations of its reality in our own personal experience. But we hardly suspected that it was going on in our own interior. Such, however, is the case; and when once one organ or structure falls behind the others in the race of growth, its neighbors promptly begin to encroach upon and take advantage of it. Emerson was right when he said, "I am the Cosmos," the universe.

Now, the mouth and the nose were originally one cavity. As Huxley long ago remarked, "When Nature undertook to build the skull of a land animal she was too lazy to start on new lines, and simply took the old fish-skull and made it over, for air-breathing purposes." And a clumsy job she made of it!

It may be remarked, in pa.s.sing, that mouth-breathing, as a matter of history, is an exceedingly old and respectable habit, a reversion, in fact, to the method of breathing of the fish and the frog. "To drink like a fish" is a shameful and utterly unfounded aspersion upon a blameless creature of most correct habits and model deportment. What the poor goldfish in the bowl is really doing with his continual "gulp, gulp!" is breathing--not drinking.

This remodeling starts at a very early period of our individual existence. A horizontal ridge begins to grow out on either side of our mouth-nose cavity, just above the roots of the teeth. This thickens and widens into a pair of shelves, which finally, about the third month of embryonic life, meet in the middle line to form the hard palate or roof of the mouth, which forms also the floor of the nose. Failure of the two shelves to meet properly causes the well-known "cleft-palate," and, if this failure extends forward to the jaw, "hare-lip." In the growth of a healthy child a balance is preserved between these lower and upper compartments of the original mouth-nose cavity, and the nose above growing as rapidly in depth and in breadth as the mouth below, the horizontal part.i.tion between--the floor of the nose and the roof of the mouth--is kept comparatively flat and level. In adenoids, however, the nostrils no longer being adequately used, and consequently failing to grow, and the mouth cavity below growing at the full normal rate, it is not long before the mouth begins to encroach upon the nostrils by pus.h.i.+ng up the part.i.tion of the palate. As soon as this upward bulge of the roof of the mouth occurs, then there is a diminution of the resistance offered by the horizontal healthy palate to the continual pressure of the muscles of the cheeks and of mastication upon the sides of the upper jaw, the more readily as the tongue has dropped down from its proper resting position up in the roof of the mouth. These are pushed inward, the arch of the jaw and of the teeth is narrowed, the front teeth are made to project, and, instead of erupting, with plenty of room, in even, regular lines, are crowded against and overlap one another.

When from any cause the lower jaw habitually hangs down, as in the open mouth, it tends to be thrown slightly forward in its socket. Then, when the jaws close again, the arches of the upper and lower teeth no longer meet evenly. Instead of "locking" at almost every point, as they should, they overlap, or fall behind, or inside, or outside, of each other. So that instead of every tooth meeting its fellow of the jaw above evenly and firmly, they strike at an angle, slip past or even miss one another, and thus increase the already existing irregularity and overlapping.

Each individual tooth, missing its best stimulus to healthy growth and vigor, firm and regular pressure and exercise against its fellow in the jaw above or below, gets a twist in its socket, wears away irregularly, and becomes an easy prey to decay, while from failure of the entire upper and lower arches of the teeth to meet squarely and press evenly and firmly against one another, the jaws fail to expand properly and the tendency to narrowing of the tooth-arches and upward vaulting of the palate is increased.

In short, we are coming to the conclusion that from half to two-thirds of all cases of "crowded mouth," irregular teeth, and high-arched palate in children are due to adenoids. Progressive dentists now are insisting upon their little patients, who come to them with these conditions, being examined for adenoids, and upon the removal of these, if found, as a preliminary measure to mechanical corrective treatment. Cases are now on record of children with two, three, or even four generations of crowded teeth and narrow mouths behind them, but who, simply by being sharply watched for nasal obstruction and the symptoms of adenoids, by the removal of these latter as soon as they have put in an appearance, have grown up with even, regular, well-developed teeth and wide, healthy mouths and jaws. Unfortunately, attention to the adenoids will not remove these defects of the jaws and teeth after they have been produced. But, if the child be under ten, or even twelve, years of age, their removal may yet do much permanently to improve the condition, and is certainly well worth while on general principles.

Take care of the nose, and the jaws will take care of themselves. An ounce of adenoids-removal in the young child is worth a pound of _orthodontia_--teeth-straightening--in the boy or girl; though both are often necessary.

The dull, dead tone of the voice in these children is, of course, an obvious effect of the blocked nostrils. Similarly, the broken sleep, with dreams of suffocation and of "Things Sitting on the Chest," are readily explained by the desperate efforts that the little one makes to breathe through clogging nostrils, in which the discharges, blown and sneezed out in the daytime, dry and acc.u.mulate during sleep, until, half-suffocated, it "lets go" and draws in huge gulps of air through the open mouth. No child ever became a mouth-breather from choice, or until after a prolonged struggle to continue breathing through its nose.

This brings us to the question, What are these adenoids, and how do they come to produce such serious disturbances? This can be partially answered by saying that they are tonsils and with all a tonsil's susceptibility to irritation and inflammation. But that only raises the further question, What is a tonsil? And to that no answer can be given but Echo's. They are one of the conundrums of physiology. All we know of them is that they are not true _glands_, as they have neither duct nor secretion, but ma.s.ses of simple embryonic tissue called _lymphoid_, which has a habit of grouping itself about the openings of disused ca.n.a.ls. This is what accounts for their position in the throat, as they have no known useful function. The two largest, or throat-tonsils, surround the inner openings of the second gill-slits of the embryo; the lingual tonsil, at the base of the tongue below, encircles the mouth of the duct of the thyroid gland (the _goitre_ gland); and our own particular Pandora's Box above, in the roof of the pharynx, is grouped about the opening of another disused ca.n.a.l, which performs the singular and apparently most uncalled-for office of connecting the cavity of the brain with the throat. They can all of them be removed completely without any injury to the general health, and they all tend to shrink and become smaller--in the case of the topmost, or pharyngeal, almost disappear--after the twelfth or fourteenth year.

Not only have they an abundant crop of troubles of their own, as most of us can testify from painful experience, but they serve as a port of entry for the germs of many serious diseases, such as tuberculosis, rheumatism, diphtheria, and possibly scarlet fever. They appear to be a strange sort of survival or remnant,--not even suitable for the bargain-counter,--a hereditary leisure cla.s.s in the modern democracy of the body, a fertile soil for all sorts of trouble.

Here, then, we have this little bunch of idle tissue, about the size of a small hazelnut, ready for any mischief which our Satan-bacilli may find for its hands to do. A child kept in a badly ventilated room inhales into his nostrils irritating dust or gases, or, more commonly yet, the floating germs of some one or more of those dozen mild infections which we term "a common cold." Instantly irritation and swelling are set up in the exquisitely elastic tissues of the nostrils, thick, sticky mucous, instead of the normal watery secretion, is poured out, the child begins to sneeze and snuffle and "run at the nose," and either the bacteria are carried directly to this danger sponge, right at the back of the nostrils, or the inflammation gradually spreads to it.

The mucous membrane and tissues of the nose have an abundance of vitality,--like most hard workers,--and usually react, overwhelm, and destroy the invading germs, and recover from the attack; but the useless and half-dead tissue of the pharyngeal tonsil has much less power of recuperation, and it smoulders and inflames, though ultimately, perhaps, it may swing round to recovery. Often, however, a new cold will be caught before this has fully occurred, and then another one a month or so later, until finally we get a chronically thickened, inflamed, and enlarged condition of this interesting, but troublesome, body. What its capabilities are in this respect may be gathered from the fact that, while normally of the size of a small hazelnut, it is no uncommon thing to find a ma.s.s which absolutely blocks up the whole of the upper part of the pharynx, and may vary from the size of a robin's egg to that of a large English walnut, or even a small hen's egg, according to the age of the child and the size of the throat.

Dirt has been defined as "matter out of place," and the pharyngeal tonsil is an excellent ill.u.s.tration. Nature is said never to make mistakes, but she is apt to be absent-minded at times, and we are tracing now not a few of the troubles that our flesh is heir to, to little oversights of hers--sc.r.a.ps of inflammable material left lying about among the cogs of the body-machine, such as the appendix, the gall-bladder, the wisdom teeth, and the tonsils. One day a spark drops on them, or they get too near a bearing or a "hot-box," and, in a flash, the whole machine is in a blaze.

Never neglect snuffles or "cold in the head" in a young child, and particularly in a baby. Have it treated at once antiseptically, by competent hands, and learn exactly what to do for it on the appearance of the earliest symptoms in the future, and you will not only save the little ones a great deal of temporary discomfort and distress,--for it is perfect torment to a child to breathe through its mouth at first,--but you will ward off many of the most serious troubles of infancy and childhood. We can hardly expect to prevent all development of adenoids by these prompt and painless st.i.tches in time, for some children seem to be born peculiarly subject to them, either from the inheritance of a particular shape of nose and throat,--"the family nose," as it has been called,--or from some peculiar sponginess and liability to inflammation and enlargement of all these tonsilar or lymphoid "glands" and "kernels" of the body generally--the old "lymphatic temperament."

We are, however, now coming to the opinion that this so-called "hereditary" narrow nose, short upper lip, and high-arched palate are, in a large percentage of cases, the _result of adenoids in infancy_ in each successive generation of parents and grandparents. At all events, there are now on record cases of children whose parents, grandparents, and great-grandparents are known to have been mouth-breathers, and who have on that account been sharply watched for the possible development of adenoids in early life, and these removed as soon as they appeared, and they have grown up with well-developed, wide nostrils, broad, flat palates, and regular teeth, overcoming "hereditary defect" in a single generation.

Curiously enough, their origin and ancestral relations may have an important practical bearing, even in the twentieth century. At the upper end of this curious _throat-brain_ ca.n.a.l lies another ma.s.s, the so-called _pituitary body_. This has been found to exert a profound influence over development and growth. Its enlargement is attended by giantism and another curious giant disease in which the hands, feet, and jaws enlarge enormously, known as _acromegaly_. It also pours into the blood a secretion which has a powerful effect upon both the circulation and the respiration. It is found shrunken and wasted in dwarfs. Some years ago it was suggested by my distinguished friend, the late Dr.

Harrison Allen, and myself, that some of the extraordinary dwarfing and growth-r.e.t.a.r.ding effects of adenoids might be due to a reflex influence exerted on their old colleague, the pituitary body. This view has found its way into several of the textbooks. Blood is thicker than water, and old ancestral vibrations will sometimes be set up in most unexpected places.

Now comes the cheerful side of the picture. I should have hesitated to draw at such full length and in such lugubrious detail the direful possibilities and injurious effects of adenoids if its only result could have been to arouse apprehensions which could not be relieved.

Fortunately, just the reverse is the case, and there are few conditions affecting the child, so common and such a fertile source of all kinds of mischief, and at the same time so completely curable, and whose cure will be attended by such gratifying improvement on the part of the little sufferer. In the first place, as has been said, their formation may usually be prevented altogether by intelligent and up-to-date hygienic care of the nose and the throat. In the second place, even after they have occurred and developed to a considerable degree, they can be removed by a trifling and almost painless operation, and, if taken early enough, all their injurious effects overcome. If, however, they have been neglected too long, so that the child has pa.s.sed the eighth or ninth year before any interference has been attempted, and still more, of course, if it has pa.s.sed the twelfth or thirteenth year, then only a part of the disturbances that have been caused can be remedied by their removal. So soft and pulpy are these growths, so poorly supplied with blood-vessels or nerves, and so slightly connected with the healthy tissues below them, that they may, in skilled hands, be completely removed by simply sc.r.a.ping with a dull surgical spoon (curette) or curved forceps, but never anything more knife-like than this. In fact, in the first seven years of life, when their removal is both easiest and will do most good, it is hardly proper to dignify the procedure by the name of an operation. It is attended by about the same degree of risk and of hemorrhage as the extraction of a tooth, and by less than half the amount of pain.

But, trifling and free from danger as is the operation, there is nothing in the entire realm of surgery which is followed by more brilliant and gratifying results. It seems almost incredible until one has seen it in half a dozen successive cases. Not merely doctors, but teachers and nurses, develop a positive enthusiasm for it. This was the operation that led to the comical, but pathetic, "Mothers' Riots" in the New York schools. The word went forth, "The Krishts are cutting the throats of your children"; and, with the shameful echoes of Kis.h.i.+neff ringing in their ears, the Yiddish mothers swarmed forth to battle for the lives of their offspring.

It is no uncommon thing to have a child of seven jump three to five inches in height, six to twelve pounds in weight, and one to three grades in his schooling, within the year following the operation. Ten years more of intelligence and hygienic teaching should see this scourge of childhood completely wiped out, or at least robbed of its possibilities for harm. When this is done, at least two-thirds of all cases of deafness, more than half of all cases of arrested development, and three-fourths of those of backwardness in children will disappear.

CHAPTER VI

TUBERCULOSIS, A SCOTCHED SNAKE

I

One of the darling habits of humanity is to discover that we are facing a crisis. One could safely offer a large prize for a group of ten commencement orations, or political platforms, at least a third of which did not announce this momentous fact. Either we are facing it or it confronts us, and unutterable things will happen unless we "gird up our loins," and vote the right ticket. An interesting feature about these loudly heralded crises is that they hardly ever "crise." The real crisis either strikes us so hard that we never know what hit us, or is over before we recognize that anything was going to happen. And most of our reflections about it are after ones--trying to explain what caused it.

In fact, in public affairs, as in medicine, a crisis is a sign of recovery. Its occurrence is an indication that nature is preparing to throw off the disease. Nowhere is this truth more vividly ill.u.s.trated than in the tuberculosis situation. When, about thirty years ago, the world began to awake from its stupor of centuries, and to realize that this one great disease alone was _killing one-seventh of all people born under civilization_, and crippling as many more; that its killed and wounded every year cast in the shade the bloodiest wars ever waged, and that it was apparently caused by the civilization which it ravaged,--no wonder that we were appalled at the outlook.

Here was a disease of civilization, caused by the conditions of that civilization. Could it be cured without destroying its cause and reverting to barbarism? Yet this very apprehension was a sign of hope, a promise of improvement. That we were able to feel it was a sign that we were shaking off the old fatalistic att.i.tude toward disease,--as inevitable or an act of Providence. It was brought about by the more accurate and systematic study of disease. We had long been sadly familiar with the fact that death by consumption, by "slow decline," by "wasting" or "slow fever," was frightfully common. "To fall into a decline" and die was one of the standard commonplaces of romantic literature. But that was quite different from knowing in cold, hard figures and inescapable percentages exactly how many of the race were killed by it. It is one of the striking ill.u.s.trations of the advantages of good bookkeeping. Boards and departments of health had just fairly got on their feet and started an accurate system of state accounts in matters of deaths and births. We were beginning to recognize national health as an a.s.set, and to scrutinize its fluctuations with keen interest accordingly.

We may decry statistics as much as we like, but when we see the effects of a disease set down in cold columns of black and white we have no longer any idea of submitting to it as inevitable. We are going to get right up and do some fighting. "One-seventh of all the deaths" has literally become the war cry of our new Holy War against tuberculosis.

Still another stirring phrase of inestimable value in rousing us from our torpor was that coined by the brilliant and lovable physician-philosopher, Oliver Wendell Holmes: "The Great White Plague of the North." This vivid epithet, abused as it may have been in later years, was of enormous service in fixing the public mind on consumption as a definite, individual disease, something to be fought and guarded against. Before that, we had been inclined to look upon it as just a natural failing of the vital forces, a thing that came from within, and was in no sense caused from without. The fair young girl, or the delicate boy whose vitality was hardly sufficient to carry him through the stern battle of life, under some slight shock, or even mental disappointment, would sink into a decline, gradually waste away, and die. What could be done in such a case, except to bow in submission to the inscrutable ways of Providence?

It seems incredible now, but such was the light in which smallpox was regarded by physicians of the Arabian and mediaeval schools: a natural oozing forth of "peccant humors" in the blood of the young, a disagreeable, but perfectly natural, and even necessary, process. For if the patient did not get rid of these humors either he would die or his growth would be seriously impaired. Now smallpox has become little more than a memory in civilization, and consumption is due to follow its example.

Sanitary pioneers had already begun casting about eagerly for light upon the influence of housing, of drainage, of food, in the causation of tuberculosis, when a new and powerful weapon was suddenly placed in their hands by the infant science of bacteriology. This was the now world-famous discovery by Robert Koch that consumption and other forms of tuberculosis were due to the attack of a definite bacillus. No tubercle bacillus--no consumption.

At first sight this discovery appeared to be anything but encouraging.

In fact, it seemed to make the situation and the outlook even more hopeless. And when within a few years it was further demonstrated in rapid succession that most of the diseases of the spine in children, of the group of symptoms a.s.sociated with enlarged glands or kernels in the neck and known as "scrofula" or struma, most cases of hip-joint disease, of white swelling of the knee, a large percentage of chronic ulcerations of the skin known as _lupus_, a common form of fatal bowel disease in children, and many instances of peritonitis in adults, together with fully half of the fatal cases of convulsions in children, were due to the activity of this same ubiquitous bacillus, it looked as if the enemy were hopelessly entrenched against attack. And when it was further found that a similar bacillus was almost as common a cause of death and disease in cattle, particularly dairy cattle, and another in domestic fowls, it looked as if the heavens above and the earth beneath were so thickly strewn and so hopelessly infested with the germs that to war against them, or hope to escape from them, was like fighting back the Atlantic tides with a broom.

But this chill of discouragement quickly pa.s.sed. Our foe had come down out of the clouds, and was spread out in battle array before us, in plain sight on the level earth. We were ready for the conflict, and proposed to "fight it out on this line if it takes all summer." It was not long before we began to see joints in the enemy's armor and weaknesses in his positions. Then, when we lowered our field-gla.s.ses and turned to count our forces and prepare for the defense, we discovered with a shock of delighted relief that whole regiments of unexpected reinforcements had come up while we were studying the enemy's position.

These new allies of ours were three of the great, silent forces of nature, which had fallen into line on either side and behind us, without hurry and without excitement, without even a bugle-blast to announce their coming.

The first was the great resisting power and vigor of the human organism, which we had gravely underestimated. The second, that power of adaptation to new circ.u.mstances, including even the attack of infectious diseases, which we call "survival of the fittest." The third, that great, sustaining, conservative power of nature--heredity. More cheering yet, these forces came, not merely fully armed, but bearing new weapons fitted for our hands. The vigor and unconquerable toughness of the human animal presented us with three glittering weapons, suns.h.i.+ne, food, and fresh air.

"If the deadly bacillus breaks through the lines, put me in the gap!

With these weapons, with this triad, I will engage to hurl him back, shattered and broken." "Equip your vanguard with them, and the enemy will never break the line."

The survival of the fittest held out to us two weapons of strange and curious make, one of them labeled "immunity," the other "quarantine."

"Give me a little time," she said, "and with the first of these I will make seven-tenths of the soldiers in your army proof against the spears of the enemy, as Achilles was when dipped in the Styx. With the other, surround and isolate every roving band of the enemy that you can find; drive him out of the holes and caves in which he lives, into the sunlight. Hold him in the open for forty-eight hours, and he will die of light-stroke and starvation. Divide and conquer!"

These reinforcements of ours have proved no mere figure of speech. They have won many a battle for us already upon the tented field. They have not merely made good their promises, but gone beyond them, and we are only just beginning to appreciate their true worth, and how absolutely we can rely upon them.

The first outpost of the enemy was captured with the suns.h.i.+ne-food-air weapons, and a glorious victory it was,--great in itself, and even more important for its moral effect and its encouragement for the future. To p.r.o.nounce an illness "consumption" had been from time immemorial equivalent to signing a death-warrant. Even the doctors could hardly believe it, when the first open-air enthusiasts began to claim that they had actually cured cases of genuine consumption. For long there was a tendency to mutter in the beard, "Well, it wasn't _genuine_ consumption, or it wouldn't have got better."

But after a period of incredulity this gave way to delighted confidence.

The open-air method would cure, and _did_ cure, and the patients remained cured for years afterward. Our first claims were barely for twenty-five or thirty per cent of the threatened victims. Then we were able to increase it to fifty per cent; sixty, seventy, and finally eighty were successively reached. But with the increase of our power over the cure of this disease came a realization of our knowledge of its limitations. It quickly proved itself to be no sovereign and universal panacea, which would cure all cases, however desperate, or however indiscriminately it was applied. And emphatically it had to be mixed with brains, on the part both of the physician and of the patient.

In the first place, the likelihood of a cure depended, with almost mathematical certainty, upon the earliness of the stage at which it was begun. Eight or ten years ago the outlook crystallized itself into the form which it has practically retained since: of cases put under treatment in the very early stage, from seventy to ninety per cent were practical cures; of ordinary so-called "first-stage" cases, sixty to seventy per cent; second-stage cases, or those in whom the disease was well developed, thirty to sixty per cent; and well-advanced cases, fifteen to thirty per cent of apparent cures. _The crux of the whole proposition lies in the early recognition of the disease by the physician_, and the prompt acceptance of the diagnosis by the patient, and his willingness to drop everything and fight intelligently and vigorously for his life. Physicians are now thoroughly awake on this point, and are concentrating their most careful attention and study upon methods of recognition at the earliest possible stages. At the same time those magnificent a.s.sociations for the study and prevention of tuberculosis, international, national, state, and local,--the greatest of which, the International Tuberculosis Congress, has just honored America, by meeting in Was.h.i.+ngton,--are straining every nerve to educate the public to understand the importance of recognizing the earliest possible symptoms of this disease, no matter how trivial they may appear, and making every other consideration bend to the fight.

This new Word of Power, the open-air treatment, alone has transformed one of the most hopeless, most pathetic, and painful fields of disease into one of the most cheerful and hopeful. The vantage-ground won is something enormous. No longer need the family physician hang back, in dread and horror, from allowing himself even to recognize that the slow loss of weight, the increasing weakness, the flushed evening cheek, and the restless sleep, are signs of this dread malady. Instead of shrinking from p.r.o.nouncing the patient's doom, he knows now that he has everything to gain and nothing to lose by promptly warning him of his danger, even while it is still problematical. On the other hand, the patient need no longer recoil in horror when told that he has consumption, and either go home to set his house in order and make his will, or hunt up another medical adviser who will take a more cheerful view of his case. All that he has to do is to turn and fight the disease vigorously, intelligently, persistently, with the certain knowledge that the chances are five to one in his favor; and that's a good fighting chance for any one.

Even should there be reasonable ground for doubt as to the positive nature of the disease, he has nothing to lose and everything to gain by taking the steps required to cure it. There is nothing magical or irrational, least of all injurious, in any way about them. Simply rest, abundant feeding, and plenty of fresh air. Even if the bacillus has not yet lodged in his tissues, this treatment will relieve the conditions of depression from which he is suffering, and which would sooner or later render him a favorable lodging-place for this omnipresent, tiny enemy.

If he has the disease the treatment will cure it. If he hasn't got it, it will prevent it; and the gain in vigor, weight, and general efficiency will more than pay him for the time lost from his business or his study. It always pays to take time to put yourself back into a condition of good health and highest efficiency.

It was early recognized that the campaign could not be won with this weapon alone. Inexpressibly valuable and cheering as it was, it had obvious limitations. The first of these was the obvious reflection that it was idle to cure even eighty per cent of all who actually developed tuberculosis, unless something were done to stop the disease from developing at all. "Eighty per cent of cures," of course, sounds very encouraging, especially by contrast with the almost unbroken succession of deaths before. But even a twenty per cent mortality from such a common disease, if it were to proceed unchecked, would make enormous inroads every year upon our national vigor.

Secondly, it was quickly seen that those who recovered from the disease still bore the scars; that while they might recover a fair degree of health and vigor, yet they were always handicapped by the time lost and the damage inflicted by this slow and obstinate malady; that many of them, while able to preserve good health under ideal conditions, were markedly and often distressingly limited in the range of their business activities for years after, and even for life. Finally, that as these cases were followed further and further, it was found that even after becoming cured they were sadly liable to relapse under some unexpected strain, or to slacken their vigilance and drop back into their former bad physical habits; while the conviction began to grow steadily upon men who had devoted one, two, or more decades to the study of this disease in the localities most resorted to for its cure, that the general vigor and vitality of these cured consumptives were apt to be not of the best; that their duration of life was not equal to the average; and that, even if they escaped a return of the disease, they were apt to go down before their normal time under the attack of some other malady. In short, _cure_ was a poor weapon against the disease as compared with _prevention_.

But before this, a careful study of the enemy's position and investigation of our own resources had brought another most important and rea.s.suring fact to light, and that is, that while a distressingly large number of persons died of tuberculosis, these represented only a comparatively small percentage of all who had actually been attacked by the disease. One of the reasons why consumption had come to be regarded as such a deadly disease was that the milder cases of it were never recognized. It was, and is yet, a common phrase in the mouths of both the laity and of the medical profession: "He was seriously threatened with consumption"; "She came very near falling into a decline,"--_but_ they recovered. If they didn't die of it, it wasn't "real" tuberculosis.

Now we have changed all that, and have even begun to go to the opposite extreme, of declaring with the German experts, "_Jeder Mann ist am ende ein bischen tuberkulose_." (Every one is some time or another a little bit tuberculous.) This sounds appalling at first hearing, but as a matter of fact it is immensely encouraging. Our first suspicion of it came from the records of that gruesome, but pricelessly valuable, treasure-house of solid facts in pathology--the post-mortem room, the dead-house. Systematic examinations of all the bodies brought to autopsy in our great hospitals and elsewhere revealed at first thirty, then, as the investigation became more minute and skillful, forty, sixty, seventy-five per cent of scars in the apices of the lungs, remains of healed cavities, infected glands, or other signs of an invasion by the tubercle bacillus. Of course, the skeptic challenged very properly at once:--